You are about to perform a rectal examination of an older adult.
- What are the steps to examine this patient?
- Explain your rationale.
- What are some findings you can have while assessing the rectal sphincter?
- Describe the differences during the rectal examination of acute prostatitis and benign prostatic hypertrophy.
- What findings would expect on physical examination of acute prostatitis and benign prostatic hypertrophy?
500 words, formatted and cited in proper current APA style with support from at least 2 academic sources
A rectal examination is a medical procedure that involves the physical examination of the rectum and surrounding structures. It is commonly performed to assess conditions related to the lower gastrointestinal tract, including the prostate gland in males. Here are the general steps involved in a rectal examination:
- Patient preparation: Explain the procedure to the patient and obtain informed consent. Ensure the patient’s privacy and comfort during the examination. It may be helpful to provide a clear explanation of the reasons for performing the examination.
- Positioning: Ask the patient to lie on their left side with their knees drawn towards their chest or in the lithotomy position (lying on their back with feet in stirrups and knees bent). These positions provide better access to the rectal area.
- Glove and lubricant: Put on a sterile glove and apply a water-soluble lubricant to your index finger.
- Inspection: Begin by visually inspecting the perianal area for any abnormalities, such as hemorrhoids, skin tags, or fissures.
- Digital examination: Gently insert your lubricated and gloved finger into the anus. Slowly advance your finger into the rectum while assessing the tone of the anal sphincter and noting any tenderness or discomfort experienced by the patient. Palpate the rectal walls, looking for abnormalities, masses, or nodules.
- Prostate examination (males only): If indicated, continue to assess the prostate gland by palpating it through the anterior rectal wall. The prostate gland can be felt as a firm, smooth structure located just anterior to the rectum. Note the size, symmetry, and any irregularities in the prostate gland.
- Withdrawal and documentation: Slowly withdraw your finger from the rectum, noting any additional findings during the withdrawal process. Document your findings accurately and in detail.
Rationale:
- The position and patient preparation ensure comfort, facilitate access, and provide an appropriate view of the rectal area.
- The inspection helps identify any visible abnormalities.
- The digital examination allows for a thorough assessment of the rectum and prostate gland, helping to identify potential pathologies.
- The documentation ensures accurate record-keeping and facilitates future reference and communication among healthcare professionals.
Now let’s discuss acute prostatitis and benign prostatic hypertrophy and their differences during rectal examination.
Acute prostatitis is an inflammation of the prostate gland that typically presents with sudden onset symptoms such as fever, chills, urinary frequency, urgency, dysuria (painful urination), and perineal or lower back pain. During a rectal examination of a patient with acute prostatitis, you may find an enlarged, tender, and firm prostate gland. The patient may experience significant pain or discomfort upon palpation of the prostate.
On the other hand, benign prostatic hypertrophy (BPH) refers to the non-cancerous enlargement of the prostate gland that commonly occurs with aging. During a rectal examination of a patient with BPH, the prostate gland is typically enlarged, but the enlargement is generally symmetrical and rubbery in texture. The patient may not experience significant tenderness or discomfort during prostate palpation.
To summarize, a rectal examination involves several steps, including patient preparation, positioning, inspection, digital examination, and documentation. The examination of acute prostatitis may reveal an enlarged, tender, and firm prostate gland, while the examination of benign prostatic hypertrophy may show an enlarged but symmetrical and rubbery prostate gland. It’s important to consult medical literature and authoritative sources for in-depth information, as well as to consult a healthcare professional for a proper examination and diagnosis.